Search Results

Lateral elbow tendinopathy: Correlation of ultrasound findings with pain and functional disability Clarke, et al. (2010) Level of Evidence : 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Intrasubstance tear CEO - Surgical management This cohort study assessed recovery with conservative treatment of people with a common extensor origin tendinopathy, focusing on the relevance of imaging findings on prognosis. A total of 62 patients were included in the present study. Patients underwent a guided exercise program under a single physiotherapist for six months. Ultrasound imaging was utilised to assess the tendon characteristics at baseline. The results showed that 30% of patients did not respond well to conservative management. Of the people who responded poorly, the majority (95%) had a large intrasubstance tear (more than 8mm tear) within the CEO and a small portion had a radial collateral ligament injury alongside the CEO tear. Those patients who responded positively to conservative treatment, the tear was smaller than 4 mm. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, large tears of the common extensor origin do not seem to respond well to conservative management compared to those people who present with smaller tears (less than 4mm). In addition, associated ligament lesions tend to be associated with worse outcomes. Based on this information, it is likely that those people with a larger tear (more than 8mm) may benefit from surgical intervention, although a trial of conservative management is warranted given the limited evidence of first line surgical approaches in tendons without obvious tears . If you identify somebody that has a mimicker of tennis elbow, but has posterolateral rotatory instability instead, this also may be best managed surgically. URL : https://doi.org/10.1177/0363546509359066 Abstract Background: Lateral elbow tendinopathy is a common condition often diagnosed by ultrasound. Debate exists regarding which ultrasound findings correlate with disease severity and prognosis. Hypothesis: Sonographic predictors for tendon healing in patients with lateral elbow tendinopathy can be found by correlating initial ultrasound findings with subsequent changes in pain and functional disability scores after a period of nonoperative management. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-two elbows (34 right, 28 left) in 62 patients (30 male, 32 female) with a clinical diagnosis of lateral elbow tendinopathy underwent sonographic evaluation of the common extensor origin after assessment with a validated outcome measure, the Patient-Rated Tennis Elbow Evaluation (PRTEE). After 6 months of nonoperative standardized treatment (physiotherapy with eccentric loading), the PRTEE questionnaire was repeated. Results: The mean pretreatment PRTEE was 78 (range, 51-97) and posttreatment score was 29 (range, 0-91). This difference in means was found to be significant ( P < .0001). A positive correlation was identified between the presence of a lateral collateral ligament tear ( P < .0001) and the size of the largest intrasubstance tear ( P < .0001) and poor outcome. A negative correlation was identified with amount of hypoechogenicity ( P = .0009). No correlation was found with age, sex, side, duration of symptoms, thickness of tendon, or amount of neovascularity. Conclusion: The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity, indicate those who may not respond to nonoperative therapy, and potentially guide more invasive treatment. Those patients with a large intrasubstance tear or tears identified on ultrasound are less likely to respond to nonoperative treatment. Presence of neovascularity has little correlation with change in pain severity or functional disability and may be a poor predictor of prognosis. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic A 27-year-old woman had a fall and was subsequently unable to move their thumb. They reported thumb pain prior to the traumatic event, but x-rays taken two years prior were clear. On objective assessment, there was laxity of the ulnar collateral ligament of the thumb mcpj. X-ray were completed and they are reported below. What is it?

Standardized definition of red flags in musculoskeletal care: A comprehensive review of clinical practice guidelines. Storari, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Red flags - Musculoskeletal care This systematic review of red flags in musculoskeletal conditions, focused on assessing whether there is consistency in the way that they are reported and applied in the literature. Red flags are critical for early detection of life-threatening or severe conditions, such as infections, fractures, tumors, visceral diseases, neurological issues, and cardiovascular problems. The review emphasised the importance of clinical guidelines and evidence-based approaches for physiotherapists and other healthcare professionals in recognising these indicators during physical examination, diagnosis, and referral processes. Unfortunately, the results outlined that there are inconsistencies on how red flags are reported and applied in clinical settings. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, "red flags" are broadly defined as signs and symptoms that aim to prevent missed diagnoses of serious underlying pathologies, which are masquerading as musculoskeletal presentations. Red flags aim to detect conditions which are not always amenable to conservative management. In hand therapy we have a few "red flags" criteria, which include but are not limited to the elbow extension test , metacarpal length ratios , and upper limb arthropathies presenting alongside other systemic signs/symptom indicative of autoimmune disease . URL : https://doi.org/10.3390/medicina61061002 Abstract Background and Objectives: The aging population and the COVID-19 pandemic have led to a rise in severe conditions, including musculoskeletal (MSK) disorders. Although MSK conditions are often managed in primary care, they may sometimes mask serious illnesses requiring urgent diagnosis. The red flag (RF) concept is essential for identifying signs and symptoms of potentially severe disease. However, RF criteria vary across clinical guidelines and lack consistency. With the growing role of direct access to physiotherapy—bypassing physician referral—physiotherapists must develop strong differential diagnostic skills to identify serious pathologies that mimic MSK disorders. This review aims to systematically map how RFs are defined in MSK clinical practice guidelines (CPGs), supporting the move toward a standardized definition for clinical and research use. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane databases. Included studies were CPGs and systematic reviews (SRs) of CPGs addressing MSK disorders and incorporating the RF concept. Data extraction followed a rigorous process, and RF definitions were synthesized and compared in table format. Results: Out of thirteen-thousand three-hundred and ninety-three articles identified, fourteen met inclusion criteria (seven CPGs and seven SRs of CPGs), spanning both physiotherapy and medical fields. All definitions described RFs as signs or symptoms indicating possible serious pathology requiring further investigation or referral. Some definitions referred broadly to “patterns of signs or symptoms”, while others offered more precise criteria. Conclusions: This review highlights the lack of a standardized RF definition in MSK care, leading to inconsistencies in clinical decision-making and diagnosis. To improve patient safety and guide clinicians—especially in direct-access contexts—a unified, internationally recognized definition of RFs is needed in future guidelines. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Which trigger digit is the most common?. Portney, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Symptom prevalence Topic : Trigger finger - Frequency occurrence This retrospective study assessed prevalence of trigger finger across all fingers and hands in a large national database of US patients. More than 1.5 millions participants were included in the study. The results showed that the middle finger was the most frequently diagnosed digit, followed by the thumb and ring finger, while the index and little fingers had the lowest rates. Approximately 33% of patients had multiple digit involvement, with symmetric patterns being common. The right hand was involved more often than the left. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, trigger finger occurs most often in the middle finger, followed by the thumb and ring finger. Of note, 1 in 3 patients exhibits multiple digit involvement with symmetrical patterns. When multiple digits are involved, the ring finger is often involved alongside the middle finger. Considering that splinting is as effective as cortisone injections and that mcpj or RME splints are effective for trigger finger , we have good options for the management of this condition. If you would like to have a look at the more research on the topic, check out the entire database . URL : https://doi.org/10.1177/17531934251348815 Abstract A national database was queried to determine the frequency of trigger finger diagnoses by digit and the frequency of multiple digit involvement. The middle finger was the most diagnosed digit, with 33% of patients having multiple digit involvement. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Predictors of successful outcomes following revision carpal tunnel release. Dondapati, et al. (2025) Level of Evidence: 2a Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Carpal tunnel surgery - Revision surgery This retrospective study assessed factors associated with a positive response to carpal tunnel surgery revision. A total of 578 participants were included, of which 57 underwent surgical revision. Patient-specific factors, such as diabetes, smoking, obesity, age, gender, and body mass index (BMI), surgical characteristics, and clinical presentation were recorded. The results showed that participants undergoing revision for pain, who smoked, or were diabetic appeared to be less likely to benefit from the surgical procedure. An CSI injection prior to revision seemed to be beneficial. This is possibly due to the fact that those who had a positive response to CSI were more likely to be offered a revision surgery. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, ongoing paraesthesia/weakness and having undergone a carpal tunnel cortisone injections seem to be correlated with a successful outcome in people undergoing carpal tunnel revision. In contrast, people who mainly report pain, who are smokers/diabetic, do not appear to have as good as a response to revision surgery . We should therefore encourage our patients to stop smoking , control weight , and take part in regular exercise to prepare them for a carpal tunnel revision. URL : https://doi.org/10.1016/j.jhsa.2025.01.007 Abstract Purpose: We sought to identify predictors of successful revision carpal tunnel release (CTR) and compare long-term patient-reported outcomes to individuals who underwent primary CTR with no revision. We hypothesized that patients undergoing revision CTR would have worse patient-reported outcomes scores compared to primary CTR at 1-year follow-up. Methods: We retrospectively compared 521 primary CTR and 57 revision CTR patients. Patients with minimum 1-year follow-up, including Patient-Reported Outcomes Measurement Information System (PROMIS) and Patient Acceptable Symptom State (PASS) scores, were included. PASS and PROMIS Upper Extremity (UE), Pain Interference (PI), and Physical Function (PF) were compared at before surgery and 1-year after surgery timepoints. Demographic and surgical data were compared using bivariate and multivariable analyses. Results: Compared with the primary CTR group, the revision group had a higher body mass index, was more likely to be male, have their dominant hand affected, have diabetes, undergo endoscopic CTR, and have concurrent cubital tunnel syndrome (CuTS). A chief complaint of pain (OR 0.23), tobacco use (OR 0.11), or diabetes (OR 0.22) were less likely to have a positive PASS response, whereas having an interval steroid injection (OR 6.2) was a predictor of a positive PASS response. PROMIS UE, PF, and PI were all similar in the primary group compared with the revision group at both before surgery and 1-year after surgery visits. None of the PROMIS modalities significantly improved at 1-year follow-up in the primary and revision groups compared to before surgery. Positive PASS response in the revision group was lower preoperatively and 1-year postoperatively compared with the primary cohort. Conclusions: Steroid injections, absence of diabetes and tobacco use, and chief symptoms of paresthesias or weakness, rather than pain, are predictors of satisfactory outcomes after revision CTR. Patients undergoing revision demonstrated lower rates of positive PASS response than primary CTR without revision at 1-year follow-up. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Understanding degenerative cervical myelopathy in musculoskeletal practice. Cervellini, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study : Diagnostic Topic : Degenerative cervical myelopathy - Hand Presentation This expert opinion described degenerative cervical myelopathy and its clinical presentation. Degenerative cervical myelopathy is the most frequent cause of spinal cord impairment in adults, yet its early stages are difficult to identify because of subtle, non‑specific symptoms that may be mistaken for routine neck or hand problems. Diagnosis requires a holistic approach that integrates patient‑reported complaints with a complete neurological examination, specific motor and sensory testing, reflex assessment, and careful observation of hand function and gait. Imaging modalities such as MRI, CT, and flexion‑extension radiographs are valuable adjuncts but are not sufficient alone. The evidence favours surgical decompression - anterior, posterior or combined - as the primary treatment for moderate‑to‑severe disease, with the aim of preventing further decline and potentially restoring neurological function. In mild cases, an initial conservative strategy that includes bracing, analgesia, therapeutic exercise and activity modification may be considered, although the long‑term benefit of such interventions remains uncertain. Early recognition by clinicians, rigorous clinical reasoning, and multidisciplinary collaboration are essential to ensure timely referral to optimise patient outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, as hand therapists we should be aware of degenerative cervical myelopathy as a differential diagnosis in patients presenting with what might look like peripheral entrapment neuropathies (e.g. carpal/cubital tunnel syndrome). Neck pain may be present in these people but it is not always the main symptom they complain of. A full neurological exam and monitoring over time of neurological function are essential. Cervical x-rays and MRIs can provide useful information regarding size of the spinal canal and whether there is evidence of demyelationion of the spinal cord (T2 images are usually useful). The benefit of early identifying people with cervical myelopathy is that surgical intervention can provide a chance for functional recovery. Evidence for long‑term benefit of conservative therapy remains limited. Other presentations that can be imitating carpal/cubital tunnel syndrome are cervical radiculopathy and neurogenic thoracic outlet . If you need a refresher for your neurological exam, have a look at this synopsis . URL : https://doi.org/10.1080/10669817.2025.2465728 Abstract Background: Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. Methods: A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. Results: A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. Conclusion: The aim of this article is to summarize and enhance physiotherapists’ essential knowledge of the differential diagnosis and management of patients with DCM. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

An uncomplicated and accurate approach to the measurement and reporting of Dupuytren’s contractures. du Plessis, et al. (2025) Level of Evidence : 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic : Dupuytren’s contractures - New measurement This expert opinion addressed the lack of standardised methods for measuring Dupuytren’s contractures, which has led to variable definitions and reporting terminology across studies. The authors propose a simple, reliable, and reproducible technique using a goniometer to measure the passive extension deficit (PED) at the metacarpophalangeal joint (mcpj) and proximal interphalangeal joint (pipj). Their method involves assessing the mcpj PED whilst in full passive pipj and dipj extension, accounting for the dynamism effect. For the pipj and the dipj the PED would be measured in full mcpj extension fist followed by mcpj flexion. This would allow for easy monitoring of disease progression and surgical outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, a new method for measuring Dupuytren's contractures on passive extension deficits (PED) at the mcpj, pipj, and dipj has been proprosed. This approach measures the passive mcpj extension whilst in full pipj and dipj extension. For the pipj and dipj the passive extension deficit is measures in full mcpj extension and flexion. This accounts for the differential contribution of the palmar lesions to the mcpj, pipj, and dipj contributions. If you would like to have a look at splinting options for Dupuytren's, have a look at this synopsis . URL : https://doi.org/10.1177/17531934251318896 Abstract There is currently no standardized method to measure Dupuytren’s contractures and the reported definitions are variable and often confusing. We present an uncomplicated and accurate measuring and reporting technique that considers the dynamism effect. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The liftmor randomized controlled trial. Watson, et al. (2018) Level of Evidence: 1b Follow recommendation: 👍 👍 👍 👍 (4/4 Thumbs up) Type of study: Therapeutic Topic : Bone mass density - Heavy lifting The study evaluates high-intensity resistance training vs low-intensity resistance training for postmenopausal women with low bone mass over 12 months. The primary objective was to assess differences on bone mineral density, muscle strength, physical function, and injuries resulting from the two training approaches. A total of 101 postmenopausal women were included in the study. The high intensity exercises trained twice a week and involved squatting, deadlifting, and shoulder pressing at 80% to 85% of their maximum capacity. In addition, people in this group underwent landing exercises from a height to expose the body to impact loading. The control group underwent resistance exercise twice a week withe resistance exercises performed at less than 60% of their maximum (e.g. lunges, calves raises). The results showed significant improvements in spine and hip bone mineral density, along with enhanced leg strength and physical performance in the high intensity resistance training group. Notably, the program was found to be both feasible and safe, with no injuries reported. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, postmenopausal women, who are at elevated risk for osteoporosis, need to lift heavy weights (80% of their maximum) and load their bones (impact exercise) to improve their bone mass density in the spine and hip. Low intensity weight lifting (<60% of maximum), is not sufficient to improve bone mass density . Heavy lifting appears to be safe and the benefit of improving bone mass density is that it will reduce fracture risks. This research is in line with more recently published papers . Remember that as hand therapists, we should screen patients at higher risk of osteopenia/osteoporosis , especially if they had a low energy fracture . If you have a hand x-ray, you can already estimate your patient's bone mass density . URL : https://doi.org/10.1002/jbmr.3284 Abstract Optimal osteogenic mechanical loading requires the application of high-magnitude strains at high rates. High-intensity resistance and impact training (HiRIT) applies such loads but is not traditionally recommended for individuals with osteoporosis because of a perceived high risk of fracture. The purpose of the LIFTMOR trial was to determine the efficacy and to monitor adverse events of HiRIT to reduce parameters of risk for fracture in postmenopausal women with low bone mass. Postmenopausal women with low bone mass (T-score &lt; –1.0, screened for conditions and medications that influence bone and physical function) were recruited and randomized to either 8 months of twice-weekly, 30-minute, supervised HiRIT (5 sets of 5 repetitions, &gt;85% 1 repetition maximum) or a home-based, low-intensity exercise program (CON). Pre- and post-intervention testing included lumbar spine and proximal femur bone mineral density (BMD) and measures of functional performance (timed up-and-go, functional reach, 5 times sit-to-stand, back and leg strength). A total of 101 women (aged 65 ± 5 years, 161.8 ± 5.9 cm, 63.1 ± 10.4 kg) participated in the trial. HiRIT (n = 49) effects were superior to CON (n = 52) for lumbar spine (LS) BMD (2.9 ± 2.8% versus –1.2 ± 2.8%, p &lt; 0.001), femoral neck (FN) BMD (0.3 ± 2.6% versus –1.9 ± 2.6%, p = 0.004), FN cortical thickness (13.6 ± 16.6% versus 6.3 ± 16.6%, p = 0.014), height (0.2 ± 0.5 cm versus –0.2 ± 0.5 cm, p = 0.004), and all functional performance measures (p &lt; 0.001). Compliance was high (HiRIT 92 ± 11%; CON 85 ± 24%) in both groups, with only one adverse event reported (HiRIT: minor lower back spasm, 2/70 missed training sessions). Our novel, brief HiRIT program enhances indices of bone strength and functional performance in postmenopausal women with low bone mass. Contrary to current opinion, HiRIT was efficacious and induced no adverse events under highly supervised conditions for our sample of otherwise healthy postmenopausal women with low to very low bone mass. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The association between the extent of sagittal band disruption and extensor tendon subluxation in different flexion angles: A cadaveric study. Vahabi, et al. (2025) Level of Evidence : 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Sagittal band lesions - Subluxations This anatomical study on cadavers, assessed the role of sagittal band integrity in maintaining extensor tendon stability at the metacarpophalangealjoint (mcpj). A total of nine cadaveric hands, the sagittal bands of the index, middle, ring, and little fingers were progressively sectioned either from the proximal or distal end in increments of 10%, 25%, 50%, 75%, 90%, and 100%. Tendon subluxation was measured at metacarpophalangeal joint positions of 0°, 45°, and 90° flexion. Even minimal (10%) sagittal band damage produced measurable subluxation, which increased progressively with greater disruption, reaching over 40% at complete sectioning. Proximal-to-distal sectioning caused greater tendon subluxation than distal-to-proximal sectioning. The little finger was resiliant to sagital band resection, with EDC subluxation occurring in only one of nine specimens. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, even small amounts of sagittal bands lesion, especially if proximal, can induce some level of EDC subluxation. The only finger that appeared to avoid EDC instability with sagittal band lesions was the little finger. It seems like the little finger, similarly to the thumb, has different anatomical variations to the ring, middle, and index finger. It also seems that FDP can be hypoplastic in the little finger compared to other fingers . URL : https://doi.org/10.1016/j.jhsa.2025.04.026 Abstract Purpose: We aimed to quantitatively assess the relationship between the extent of sagittal band damage and tendon stability across different fingers and positions while also examining the effects of proximal versus distal damage. Methods: This was a cadaveric study conducted on the index, middle, ring, and little fingers of nine cadavers. Damage was induced through stepwise sectioning either from the proximal or distal end. Sectioning was performed in increments of 10%, 25%, 50%, 75%, 90%, and 100%. Photographs were taken to measure subluxation at metacarpophalangeal joint positions of 0°, 45° flexion, and 90° flexion. Data from the index, middle, and ring fingers were pooled, whereas data on the little finger were analyzed separately. Results: Subluxation was greater with proximal to distal sectioning at 25%, 75%, and 90% damage thresholds. Ten percent sectioning resulted in a mean subluxation of 5.1% (95% confidence interval [CI], 2.5–7.7); 25% sectioning led to a mean subluxation of 13.6% (95% CI, 7.9–19.3); 50% sectioning resulted in a mean subluxation of 15.3% (95% CI, 9.2–21.3); 75% sectioning resulted in a mean subluxation of 18.1% (95% CI, 12.2–23.9); 90% sectioning led to a mean subluxation of 24.1% (95% CI, 17.5–30.7); and 100% sectioning resulted in a mean subluxation of 41.6% (95% CI, 33.7–49.5). Regarding the little finger, complete dislocation occurred in only one of the nine fingers. Conclusions: Even minimal sagittal band damage results in measurable subluxation, but the presence of even 10% intact fibers confers some stability against subluxation. As the extent of sagittal band disruption increases, the extensor tendon progressively deviates from its native position. Damage to the proximal fibers has a more detrimental impact on tendon stability. Clinical relevance: The relationship between sagittal band integrity and tendon stability extends beyond a simple dislocation threshold. Both the extent of damage and location of the disrupted fibers are associated with the degree of subluxation. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Anatomical distribution and treatment of paediatric hand fractures: A multi-centre study of 749 patients in the netherlands. de Haas, et al. (2025) Level of Evidence : 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Pediatric fractures - Management This multicentre cross-sectional study investigated treatment variations for pediatric hand fractures in the Netherlands. A total of 749 pediatric, across multiple hospitals, were included in the study. The majority of the injuries were low energy trauma (90%) whilst a smaller number was the result of crush injuries (10%). Physeal fractures were the most common (20%) followed by volar plate avulsions. For an extensive description of the fractures included in the study, have a look at the figure below. The large majority of fractures were treated with immobilisation (circa 60%), followed by some gentle mobilisation (circa 40%). Less than 4% of all fractures underwent surgery. The fractures that were managed with surgery included phalangeal and metacarpal shaft fractures as well as intra-articular fractures. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, clinicians can choose to either immobilise or initiate early motion in pediatric patients with hand/finger fractures in most cases. Shaft or intra-articular fractures present with a lower threshold for for surgical interventions as these may cause finger scissoring or intra-articular step deformities, which may required more invasive treatment. If you are interested in pediatric hand therapy care, have a look at the whole database on the topic . URL : https://doi.org/10.1177/17531934241258862 Abstract This study describes the anatomical distribution of paediatric metacarpal and phalangeal fractures and evaluates treatment methods for each fracture type. A multicentre study was conducted over a 3-month period in the Netherlands. A total of 749 consecutive patients, aged 0–17 years, with single metacarpal or phalangeal fractures were included. Physeal fractures of the proximal phalanx were most common ( n = 135, 17%), followed by proximal interphalangeal joint palmar plate avulsion fractures ( n = 81, 10%) and proximal phalanx shaft fractures ( n = 80, 10%). Treatment methods varied: 63 (47%) patients with proximal phalanx physeal fractures were allowed mobilisation of their fingers, while 70 (51%) were immobilised; 53 (65%) patients with proximal interphalangeal joint palmar plate avulsion fractures were allowed mobilisation, while 28 (35%) were immobilised; and 33 (41%) patients with proximal phalanx shaft fractures were allowed mobilisation, while 42 (52%) were immobilised. The study identified substantial treatment variability in common fractures, providing information and insights for future research directions. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The risk of surgical site infection for hand trauma surgery performed outside main theatres: A systematic review and meta-analysis. Shafi, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic : Simple hand surgeries - Outside main theatre This systematic review and meta-analysis assessed the risk of surgical site infections in hand trauma surgery performed outside the main theatre (OMT). A total of 1,635 participant across seven studies were included in the study. The Cochrane Risk of Bias Tool was utilised to assess the quality of the studies. The surgeries performed included fracture fixations with k-wires or plates and screws, as well as soft tissue repair (e.g. extensor or flexor tendon repair). The results showed that the risk of surgical site infections in OMT settings was low, with an estimated risk of 2.8% (CI 2.1–3.8%). Despite these findings, it is important to keep in mind that there was only one randomised controlled trial and that the other were cohort studies that presented with missing data. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the risk of surgical site infections in hand trauma surgery performed outside the main theatre (OMT) appears to be similar to what has been reported in main theatre . It is likely that we will be seeing more OMT surgeries as the ratio of theatres to population shrinks. It is also possible that in the future of hand therapy we will have some advanced scope practitioners performing some of simpler surgeries due to shortages of available specialists. URL : https://doi.org/10.1177/17531934251345358 Abstract Increasing pressure on healthcare systems and limited emergency operating capacity has reduced the availability of main theatres for hand trauma surgery. This has led to an increase in hand trauma surgery performed outside the main theatre (OMT). Data on the risk of surgical site infection (SSI) in the OMT setting for hand trauma are limited. This systematic review and meta-analysis summarize the risk of SSI for hand trauma surgery in this setting. We included seven studies involving 1635 patients. The meta-analysis suggests an SSI risk of 2.8%, which is a lower estimate than the overall risk of SSI in hand trauma surgery. Hand trauma surgery performed OMT is not associated with an increased risk of SSI compared with existing summary estimates. This supports recent guidelines from the British Society for Surgery of the Hand, and Getting It Right First Time programme. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Exercise for postmenopausal bone health: Can we raise the bar?. Kumar, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Bone health - Weight lifting and impact training This narrative review discussed the importance of high-intensity resistance and impact training (HiRIT) in promoting bone health, particularly among postmenopausal women with osteopenia or osteoporosis. Despite initial safety concerns, recent evidence demonstrated that HiRIT is effective in stimulating bone growth and improving musculoskeletal outcomes. The study also addresses the challenges of muscle and bone loss during weight-loss therapies, emphasising the role of resistance exercise in preserving lean muscle mass and bone density. While a wealth of research underscores the benefits of exercise for bone health, several unanswered questions remain, including how to sustain long-term osteogenic responses and the mechanisms underlying skeletal adaptations. The potential integration of exercise with pharmacotherapy offers promising avenues for more effective approaches to treating osteoporosis in aging populations. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, high-intensity resistance and impact training (HiRIT), which involves weight lifting and jumping/jogging, can reverse bone loss in postmenopausal women with osteopenia or osteoporosis. This seems to be in line with what previous evidence has suggested . This information is useful as we see lots of clients with fragility fractures (e.g. low energy distal radius fracture) who would benefit from this type of training. For a simple screening, you can even assess bone mass density from your clients' hand x-rays . URL : https://doi.org/10.1007/s11914-025-00912-7 Abstract Purpose of Review: This review summarises the latest evidence on effects of exercise on falls prevention, bone mineral density (BMD) and fragility fracture risk in postmenopausal women, explores hypotheses underpinning exercise-mediated effects on BMD and sheds light on innovative concepts to better understand and harness the skeletal benefits of exercise. Recent Findings: Multimodal exercise programs incorporating challenging balance exercises can prevent falls. Emerging clinical trial evidence indicates supervised progressive high-intensity resistance and impact training (HiRIT) is efficacious in increasing lumbar spine BMD and is safe and well-tolerated in postmenopausal women with osteoporosis/osteopenia. There remains uncertainty regarding durability of this load-induced osteogenic response and safety in patients with recent fractures. Muscle-derived myokines and small circulating extracellular vesicles have emerged as potential sources of exercise-induced muscle-bone crosstalk but require validation in postmenopausal women. Summary: Exercise has the potential for multi-modal skeletal benefits with i) HiRIT to build bone, and ii) challenging balance exercises to prevent falls, and ultimately fractures. The therapeutic effect of such exercise in combination with osteoporosis pharmacotherapy should be considered in future trials. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings